Compound fracture of humeral shaft associated with two-part fracture dislocation of ipsilateral shoulder: a rare combination

Abstract

Humerus fracture is very rarely associated with ipsilateral shoulder dislocation. Here, we have reported probably the first case of compound fracture of humerus associated with a two-part fracture dislocation of ipsilateral shoulder. A 30-year-old female presented to the emergency department after a road traffic accident. The vehicle in which she was travelling skidded off the road and she got trapped. She had degloving injury over her left arm with a fracture of left humerus and anterior dislocation of ipsilateral shoulder and greater tuberosity fracture. She was managed initially with wound debridement, external fixation over humerus, closed reduction of shoulder dislocation, and open reduction and internal fixation of greater tuberosity fracture. Skin grafting was done over the wound later on. Fracture united at 4 months with a good range of movement at shoulder at the final follow-up.

Case report of ipsilateral humeral shaft fracture and shoulder dislocation treated by closed reduction followed by intramedullary nailing

“…Finally, in one case report, external fixation was selected because the skin had a degloving injury. After external fixation, reduction of shoulder dislocation was performed [7] . Although neurovascular injury can be prevented, external fixation may not be ideal in terms of rehabilitation and patient convenience in cases without degloving injury or any other skin injury.…”

Management of Dislocation of the Shoulder Joint with Ipsilateral Humeral Shaft Fracture: Initial Experience

“…Lack of adequate lever arm to conduct the closed reduction of the joint and the unstable fracture may increase the risk of failure and iatrogenic neurovascular damage. Based on this viewpoint, some authors advocate that fixation of humeral shaft fractures should be performed prior to joint reduction 5,8,12,15,16,18,21 . However, in our study, closed manipulative reduction of the shoulder joint succeeded in six patients with mid-distal humerus fractures but failed in case 1 with interposition of the tendon and cases two and six with proximal humerus fractures.…”

“…However, by reviewing the literature we could see that when shoulder dislocation is complicated with an ipsilateral humeral shaft fracture, there is still no consensus on the management, especially on the reduction sequences of dislocation. Some case reports show a successful closed reduction of the shoulder joint, but some failed [5][6][7][8][9][10][11][12][13][14][15][16][17][18][19][20][21] . The major obstacle in achieving closed reduction is lack of adequate lever arm, which demands surgical intervention to fix the shaft, followed by closed reduction.…”

“…Gupta et al 16 fixed the shaft fracture with an external fixator prior to shoulder reduction. Kapila et al 23 used open reduction with the standard deltopectoral approach to fix the shaft fragment with a long plate first, after which closed reduction of the joint was done.…”

Shoulder Dislocation with Head and Shaft Fracture Ipsilateral

“…Case reports in the literature have advocated two possible mechanisms of injury. Sankaran-Kutty and Sadat-Ali [6] suggested that the force exerted along the axis of the humerus simultaneously fractured the humerus and dislocated the shoulder, whereas Kontakis et al [7,8] proposed that the shoulder dislocated first and subsequent, bending or torsion forces fractured the shaft of humerus. We believe that the mechanism of injury in our patient was as described in the second case, and this is supported by the fracture pattern that is spiral and acute bending of the arm during emergency presentation.…”